P160
A Case report: Hypoparathyroidism, nephrocalcinosis and
replacement therapy
Boysan S Nur1, Ozgen Zeren2, Sahin Tuna3
1 Department of Endocrinology
2 Department of Nephrology
3 Department of Radiology
Kahramanmaras Necip Fazıl City Hospital ,Kahramanmaras, Turkey
Introduction
• The objectives of treatment in hypoparathyroidism are
controlling symptoms and maintaining serum calcium in the
low-normal range and serum phosphorus within a normal
range without developing hypercalciuria and
nephrocalcinosis.
• We present a case who has hypocalcemia and
hyperphosphatemia and also nephrocalcinosis.
Case Report
Medical history
• A fifty-years old man was admitted to hospital for routine
visit .
• At the age of 24, in Neurology department basal ganglion
calcification was diagnosed caused by hypoparathyroidism.
• Medical treatment was included oral daily 1,25(OH)2D
0.25 mcg, 1333 IU Vit D, and 2500 mg calcium carbonate
and also 880 IU Vit D3.
Laboratory
Calcium 7.6 mg/dl
Phosphorus 5 mg/dl
Parathormon 4 pg/dl
Creatinine 1.3 mg/dl
Radiology
• Renal ultrasonograpy showed bilateral extensive
medullary hyperdense images diagnosed as
nephrocalcinosis.
Treatment
• Medical treatment was changed to daily 1,25(OH)2D 0.25
mcg 2x1, 2500 mg calcium carbonate and also 880 IU Vit
D3 .
• We followed serum calcium and phosphorus monthly,
serum creatinine every 3 month and renal ultrasonography
every 6 month.
Results of the 6th month
Calcium 8.8 mg/dl
Phosphorus 4.1 mg/dl
Creatinine 1.3 mg/dl
• Renal ultrasonography showed slightly increased hyper
echogenity of medullary more distinctive in the left renal
images.
Right renal image Left renal image
Conclusion
• In autosomal dominant hypoparathyroidism, heterozygous
activating mutations of the CaR gene reset parathyroid and
kidney causing hypocalcemia and hypercalciuria.
• Vitamin D treatment results in further hypercalciuria and
nephrocalcinosis..
• Some literature suggests the use of injectable
parathormon(1-34) when nephrocalcinosis developed in
the treatment of hypoparathyroidism but some results
showed no difference when compared with conventional
therapy.
• In addition, parathormon is not approved by FDA for use in
hypoparathyroidism in USA because of the unknown risk of
osteosarcoma.
• In Turkey we can only use as a drug except of indication
with the permission of Health Ministry.
• In this case: changing medical treatment to more potent
calcitriol which has a rapid onset and offset rather than Vit
D provided us to keep serum calcium level near the lower
limit and also some degree of improvement in
nephrocalcinosis.